Monday, September 14, 2015

The Role of Ovarian Stimulation Injections in IVF

If you are considering doing IVF, you’re sure to have read that injections which help you to grow eggs ( this is called ovarian stimulation or superovulation) play a crucial role in the treatment. Most of our patients are pretty well-informed about the ovarian stim procedure, but they still want more clarity about how these work. The drugs used to stimulate your ovaries in IVF treatment are gonadotropins (hMG & rFSH), and are available in many different brand names.

The Questions

They have a range of questions for me including:
•Do they have any side effects?
•If I am ovulating, then why do I need these?
•Will they increase the risk of cancer?

The Facts

Here are some facts that will answer some of those questions.

•Hormones are Required for Normal Ovulation- In their reproductive years, women ovulate normally every month; this is why they also have regular periods. A woman is always born with all the eggs that she will ever have. The pituitary gland produces the follicle stimulating hormone. This causes very rapid growth in a group of follicles. Each month, only one egg matures and it’s released- this is known as ovulation.

If the egg gets fertilized and implants in the woman’s uterus, she becomes pregnant. If that doesn’t happen, the egg will be shed with the endometrium (the uterus lining), and she will have per period. After the age of 40, a woman’s periods start becoming irregular- this is called oopause/perimenopause. Over time, her periods will stop and if she hasn’t had her period for a year, it’s an indication that she has entered menopause. The average age that women reach menopause is 50 years.

•Age & Reduced Ovarian Reserve- There is a decline in fertility once a woman reaches 30. But it’s not just the quantity of eggs that reduces; there is a dip in the quality of eggs too. This is referred to as oopause. By the time women are in their mid-thirties, their fertility begins to drop and by this age, most won’t be able to have a successful pregnancy without the help of ART (assisted reproductive technology). Women with poor ovarian reserve also have a much lower chance of getting pregnant, versus those who have normal ovarian reserve (in that same age group)

•Medicine Dosage- Before you start on IVF treatment, your doctor first orders some tests- these check ovarian reserve and include a blood test for AMH level as well as an antral follicle count. On the basis of all the results, the doctor will then develop a treatment plan for you. The dose of injections used for superovulation is a critically important choice . While a good doctor can use his experience and expertise to select the dose which he thinks is right for you, this does involve some trial and error as well, because every woman is different.

•Ovarian Stimulation in IVF- The thing you need to understand here is that all your eggs aren’t created equal. We use ovarian stimulation in IVF treatment in order to stimulate your ovaries to produce more eggs. Once these are retrieved, they will then be fertilized in the IVF lab. Like I mentioned, not all eggs are the same and when we have multiple eggs, it gives us the opportunity to carefully select & fertilize only the high quality ones, for a positive outcome.

Testing and More

Your IVF doctor will also monitor you very closely when gonadotropins are being used in your treatment. Blood tests & transvaginal ultrasounds will be done to check how your follicles are developing. In addition, it helps us check whether you are at risj for developing OHSS (ovarian hyperstimulation).